Christie Urges Mandatory CME on Opioid Prescribing

Opioid commission head says it should be DEA licensing requirement

BALTIMORE, Md. -- Physicians should be required to take continuing education classes on opioid prescribing in order to maintain their Drug Enforcement Administration (DEA) prescribing licenses, New Jersey Governor Chris Christie (R) said Tuesday at a congressional field hearing here on the opioid crisis.

"This drug epidemic didn't start on the street corners of Baltimore; it started in doctors' offices and hospitals across the nation," Christie, who led President Trump's commission on the opioid crisis, said at the House Oversight and Government Reform Committee hearing at Johns Hopkins Hospital. "And while some of it is done by folks who have bad intent, most is done by those with no intent. Why no intent? Because they're not educated on this issue."

"We're not educating our future doctors, nurses, and dentists on the dangers of these drugs," he continued. "We grant DEA licenses to write opioid prescriptions without requiring continuing medical education on opioid addiction. I, as a lawyer, I have to take continuing education to maintain my license; how is it that physicians could have a DEA license and not be required to take continuing medical education on this problem when 64,000 people died from it last year?"

States Should Take the Lead

What little education physicians do get comes from the pharmaceutical manufacturers themselves, Christie added. "Right now, the doctors only get education from the companies that are producing the pills they want them to prescribe ... We're 4% of the world's population and we consume 85% of the world's opioids. That's why we brought together [NIH Director] Francis Collins and all of the pharmaceutical executives and got them to agree to a partnership where we will work with NIH on two solutions to this problem: more non-opioid painkillers and more alternatives to medication-assisted treatment."

Committee member Rep. James Comer (R-Ky.) asked Christie how Congress could best support state and local government efforts to fight the epidemic. "The battle will be won with the state and federal government, with the state government taking the lead," he said. "Our view is that there should be accountability block grants -- block grants should be sent to states and Congress should be demanding accountability from the state in return for block grants. Force me as a governor to be accountable for what I'm doing."

The states should determine which programs will work for them, he added. "It's difficult to determine which programs are going to be necessary and effective in all 50 states."

Committee member Rep. Brenda Lawrence (D-Mich.) complained that the Trump administration didn't allocate additional funding to fight the epidemic even after Christie's commission came out with a report recommending specific actions to be taken. "It's time for us to have a real discussion on this," she said. "It's not good enough to get a commission together to write an excellent report if you don't fund it."

But it's not just lack of federal funding that's a problem -- insurers also aren't doing their fair share when it comes to paying for opioid addiction treatment, said Christie. He noted that the law that requires mental health and substance abuse treatment to be on a par with physical health treatment doesn't include penalties for insurers who don't comply. "We're not enforcing that [for] private insurers ... If all you do is ask, 'Would you please do this and if you don't, there's no penalty,' it's just a feel-good piece of legislation."

Implementing the Recommendations

Rep. Jamie Raskin (D-Md.) wanted to know who would be responsible for implementing the recommendations in the Christie commission's report. "Who's the boss now? Who's in charge of implementing all these recommendations across the federal government?"

"The president has to be the leader," Christie responded. "He's the person who empowered the commission and is responsible for making sure the laws are executed ... [Each cabinet member] should be empowered to say what section of the report is theirs, and report back to the president [on their progress]."

Christie bristled at Raskin's suggestion that the president wasn't taking enough of a leadership role in implementing the report. "Before this president, you didn't see a national commission on this problem ... Neither [President] Obama nor [President George W.] Bush empowered a commission to come up with recommendations ... This president is the one who declared it an emergency."

Raskin really wanted to find out if Christie, whose governorship ends at the end of this year, would be willing to spearhead the effort himself, "but I didn't get a chance to get there," he told MedPage Today during a break in the hearing. "However, I was very convinced, both by the report and by Christie's presentation here, that he's deadly serious about the issue, and I would encourage the president to name him the opioid crisis czar and to make the recommendations happen."

Fentanyl Making Things Worse

The opioid crisis is getting even worse thanks to the influx of fentanyl and carfentanil -- both much more powerful than heroin or prescription opioids -- from China, Christie said. "Fentanyl will take this crisis to next geometric explosion ... It's so lethal that law enforcement officers who come to crime scenes have to be careful with way they deal with it so they don't expose themselves to an overdose.

"We need to make clear to the Chinese that this is an act of war; you are sending this into our country to kill our people. Any foreign country... who is willfully allowing this to be done is committing an act of extraordinary aggression on our country and needs to be met with an appropriate response."

Asked to name his top three priorities for dealing with the crisis, Christie listed taking action toward China on fentanyl and carfentanil; education of prescribers on opioids; and more funding for treatment. "When 10.6% of people who need treatment are getting it, we need to do better."

Committee members also heard from local experts about their problem. Baltimore Health Commissioner Leana Wen, MD, testified that the anti-overdose drug naloxone has become so expensive that she has had to ration it. "We have 8,000 units left between now and July 2018 ... but if I got 8,000 more units today, I could distribute them all by this weekend."

Ideally, she said, "I would like everyone in our city to carry naloxone in their medicine cabinet or first aid kit. And why shouldn't it be available in every public place the way we have defibrillators available in public places?"

Committee chairman Rep. Trey Gowdy (R-S.C.) expressed hope that Congress could work in a bipartisan fashion to combat the problem. "Although almost everything seems capable of being reduced to a political exercise, I genuinely hope this epidemic is above that," he said. "We can put people on the moon and split atoms, but we're struggling with how to respond to this epidemic."

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